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Assessing Impact of Parkinson Disease Symptoms on Caregivers, Patients Amid COVID-19


In assessing symptoms of Parkinson disease exacerbated by the coronavirus disease 2019 (COVID-19) pandemic, nonmotor neuropsychiatric and automatic symptoms were noted to particularly affect both patients and their respective caregivers.

In assessing the mental and physical symptoms of Parkinson disease (PD) exacerbated by the coronavirus disease 2019 (COVID-19) pandemic, nonmotor neuropsychiatric and automatic symptoms were noted to particularly affect both patients and their respective caregivers, according to study findings published in Movement Disorders Clinical Practice.

Reported studies on the effect of the COVID-19 pandemic on patients with PD (PwP) have reported several implications, notably on mental health. In the general population, a poll by Lyra Health and the National Alliance of Healthcare Purchaser Coalitions indicated that more than 80% of US workers are experiencing mental health issues.

Pairing this information with the known mental health burden on PwP, who are at greater risk of mood changes (eg, anxiety, depression), authors of the current study sought to examine whether the pandemic led to the worsening of symptoms in PwP. Moreover, they wanted to see if it also affected the mental health of caregivers, which has been shown to correlate with the level of symptom control in PwP.

“We hypothesized that different PD features may impact on patients’ and caregivers’ stress under lockdown,” noted the study authors.

Researchers designed a prospective study of telephone interviews conducted by the treating neurologist of each PwP and their caregiver (N = 32) during the last 10 days of lockdown in Italy. Stress level of PwP and their caregivers was compared with the time prior to home confinement and assessed with a self-reported judgment rating scale, which was categorized as worsened (score 0-2) and unchanged/improved (score 3-6). Several clinical variables were assessed in PD:

  • Unified PD Rating Scale Part II
  • Non-Motor Symptoms Scale (NMSS)
  • Questionnaire for Impulsive-Compulsive Disorders in PD–Rating Scale
  • PD Questionnaire-8

Hospital Anxiety and Depression scale (HADS) scores were provided by PwP and caregivers, who also completed the Zarit Burden Interview. PwP were additionally categorized in 2 groups based on whether they exercised for at least 45 minutes per day during home confinement.

In the study findings, level of stress during home confinement was rated as worsened in 43.8% of PwP and 53.1% of caregivers. Among PwP who had reported increased stress levels, HADS-Anxiety (P = .006) and NMSS (P = .012) scores were additionally worsened.

These intensified NMSS scores were shown to correlate with worsening of stress among caregivers (P = 0.018). Conversely, after conducting a multivariate binary logistic regression analysis, worsening stress in caregivers was also associated with patients’ HADS-Anxiety scores (P = .032) and NMSS scores (P = .018). A higher Zarit Burden Interview score in caregivers was associated with a higher NMSS score in PwP as well (P = .029).

PwP who had practiced daily exercise exhibited lower scores on HADS-Anxiety compared with those who were inactive (6.0 ± 3 vs 8.7 ± 3; P = .044).

In addressing the study findings, researchers note that the COVID-19–related confinement period resulted in an additional load of pressure on caregivers, which was especially affected by patients’ nonmotor symptoms belonging to the neuropsychiatric and autonomic domain. Anxiety was the sole significant determinant of worsening stress in PwP.

“Despite the small sample size and the use of a nonvalidated outcome measure such as the verbal rating scale, we believe these findings should be taken into account in the postpandemic time,” wrote the study authors. “Moreover, our study highlights that, under strict home confinement, different PD symptoms have a distinct but significant impact not only on patients’ but also on caregivers’ stress.”


Oppo V, Serra G, Fenu G, et al. Parkinson disease symptoms have a distinct impact on caregivers' and patients' stress: a study assessing the consequences of the COVID-19 lockdown. Mov Disord Clin Pract. Published online September 16, 2020. doi:10.1002/mdc3.13030

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